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Hamstring reinjuries often occurred in same location as index injuries
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Investigators reported the biceps femoris muscle was injured 79% of the time among 19 hamstring reinjuries they studied. This was the same muscle injured 95% of the time in index hamstring injuries.
According to study findings, within the biceps femoris muscle, the most common location of reinjury was the musculotendinous junction, which was the case in 13 of the reinjuries. The investigators also found no significant differences in MRI characteristics for the index hamstring injuries and reinjuries studied. Investigators noted that, based on MRI severity grading, 73% of reinjuries were about as severe as the corresponding index injuries. However, when they compared the reinjury site with that of the index hamstring injury, the most severe reinjuries occurred in the same location. In addition, more than half the hamstring reinjuries evaluated occurred within the first 4 weeks after athletes returned to sport (RTS) following their initial injuries.
The investigators noted the study had some limitations. The RTS, although well defined, was sometimes controlled by the club physiotherapists or physicians and could have varied. Furthermore, the investigators included athletes with a reinjury within 1 year of RTS, “but it may be argued that this time limit is artificial. The number of included athletes with a reinjury was relatively small, although this is the largest study to date. To obtain larger samples, multicenter studies might be more appropriate,” they wrote. – by Susan M. Rapp
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopCarl M. Askling, PhD
This is a descriptive study on a “hot” topic.
The return to sport from acute hamstring injury is a difficult, multifactorial decision and there is no consensus on a single clinical or functional test or imaging investigation that provides strict criteria for safe return.
The high reinjury rates indicate an inadequate rehabilitation program or a premature return to sport, and, in the worst case, a combination of both.
Do the L-protocol and Askling H-test eliminate re-injuries? Two recent studies on Swedish elite football players and Swedish elite sprinters and jumpers, respectively, showed a rehabilitation protocol consisting of lengthening type of exercises (L-protocol) were significantly more effective (days) to promote return compared with a conventional protocol (C-protocol) after acute hamstring injuries.
An active, ballistic hamstring flexibility test, the Askling H-test, could provide useful additional information to the common clinical examination before allowing return to sport. A combination of L-protocol and Askling H-test seems to be effective to both promote return and to avoid re-injuries, based on studies by Askling CM, and colleagues from 2010, 2013 and 2014.
References:
Askling CM, et al. Br J Sports Med. 2013;doi:10.1136/bjsports-2013-092165.
Askling CM, et al. Br J Sports Med. 2014;doi:10.1136/bjsports-2013-093214.
Askling CM, et al. Knee Surg Sports Traumatol Arthrosc. 2010;doi:10.1007/s00167-010-1265-3.
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